Foreskin or No Skin? Let’s Talk About Circumcision

In Male Pelvic Pain by Stephanie Prendergast9 Comments

By Rachel Gelman

In my previous post I talked about the anatomy of the male pelvic floor. The blog stirred up a lot of conversation among readers, with many requesting a part two. So here we are! This time, we’ll  take a look at a small part of the male anatomy that comes with a large amount of controversy: The foreskin.

This little piece of skin has inspired a coalition of activists to form called the Intactivists.  Known for opposing circumcision, their goal is to educate the world about the benefits of foreskin. They sport T-shirts with witty catchphrases including “Take the whole baby home!” or “His Body, His Choice!” (Feel free to check out all the options and maybe do some early holiday shopping here). All this fuss over an area of the body made me wonder, what’s the big deal over something so small? Why did doctors even decide to remove it in the first place? Why are people fighting so hard to get parents to keep their sons intact? So, I put on my detective hat and went searching for the answers!

 

First, let’s start with a basic anatomy lesson. Foreskin is a sheath of skin that covers the tip or glans of the penis. It is also called the male prepuce and is homologous to the clitoral hood, which covers and protects the clitoris in women. Foreskin is comprised of an inner and outer layer, with the outer layer being continuous with the skin of the shaft of the penis, while the inner layer is mucosal tissue, much like the inside of your mouth. In uncircumcised boys, the foreskin and glans are fused together at birth, and slowly separates as a boy ages. Once he hits puberty, the foreskin should easily retract (this is also the recommended strategy to keep the glans and area under the foreskin clean). The foreskin attaches to the base of the penis at the frenulum which is an elastic band and helps retract the foreskin during an erection. When the penis is flaccid, foreskin may completely or partially cover the glans. However, when the penis is erect the foreskin will fully retract and look the same as a circumcised penis. So if in the end they both look identical, why should we even care about it?

 

Foreskin, Restoration, Penis, scar, trauma, babies,
Well as it turns out, other than covering the glans of the penis the foreskin has several beneficial functions (keeping the glans warm for the winter is still debatable) that you may not be aware of.  The foreskin keep the glans moist and well lubricated due to the mucosal nature of the inner layer of skin. When dry skin combines with the skin oils it produces smegma, which is what helps lubricate the glans and some report this added lubrication can help during sexual activity. Some argue that the foreskin is like a little suit of armor for the head of the penis because when circumcised, the penis is exposed to more external stimuli such as clothing, which may cause discomfort or chaffing.

Enter the Intactivists, they believe that this increase in exposure to the glans may lead to decreased sensitivity and sexual pleasure. Furthermore, they also argue that the foreskin is important for sexual function and is considered an important erogenous zone in men. Many believe the foreskin creates a gliding action that aids in masturbation and intercourse to allow for increased sexual satisfaction. Some research has reported increased nerve endings, which are also found in the fingertips and the lips, at the frenulum and in the foreskin itself.  However, research continues to be inconclusive. Now you  may be thinking what I’m thinking; foreskin sounds great! Why would physicians ever remove it? The answer may lie in tradition.

 

Circumcision is actually one of the oldest planned medical procedures performed. Mostly associated with the Jewish faith, circumcision is part of a ritual performed shortly after a boy is born. However, many other cultures perform circumcisions for religious reasons or as a rite of passage to signify a boy has become a man, or as a sign of bravery. Circumcisions in America became more prevalent in the Victorian Era as a means to prevent males from maturbating. Doctors also recommended removing foreskin to prevent a variety of conditions including: clubfoot, epilepsy, mental illness, convulsions, tuberculosis and hydrocephalus. I even found records that the military recommended circumcisions in the event soldiers needed to fight in the desert to avoid infections due to sand accumulating under the foreskin.

 

Some research indicates that circumcision helps reduce STDs and HIV infection rates. However, many of the research was performed in regions of Africa so the data may be skewed. The World Health Organization does continue to recommend circumcision for populations at high-risk for contracting HIV to help prevent the spread of the disease. Finally, many people have their son’s circumcised to prevent certain complications that can occur if the foreskin becomes too tight/can no longer retract and restricts the glans (phimosis) or inflammation and infection of the glans, usually due to poor hygiene (balanitis). As you may have caught on, the Intactivists disagree with this too, and argue that these conditions are rare and can be easily prevented with proper hygiene

 

Perhaps, the biggest, and what I found to be the most compelling argument from the Intactivists as to why one should not circumcise their son, is because one would not circumcise their daughter. Again, the clitoral hood is the same as the male foreskin. So why is it ok to remove something from one gender, but not the other? The cultural and religious ceremonies that make male circumcision a rite of passage rather than a medical procedure make answering this question more complex, hence the controversy around it. Still, Intactivists argue that a man should be in charge of deciding if he wants to be circumcised, and males should be left intact so that they can decide when an adult.

 

It is definitely easier to keep a foreskin and decide to have it removed later in life; than to remove it only to have the male  want it back. With that said, I found a lot of wild D.I.Y foreskin restoration methods online.  I doubt these are on many Pinterest boards, but they made it onto ours! Check them out here:  However, I highly advise that one DOES NOT attempt to restore his own foreskin with any of these “at-home” methods. They can easily cause damage to your penis or can result in pelvic floor dysfunction because of the consequences of the suggested strategies (trust me, I’ve seen it happen)!

 

If getting your foreskin back is something you are really interested in, consult with a doctor to see what options may work best for you. More often than not, men seek out foreskin restoration in hopes of improving their sexual function, but other physiological or psychosocial factors may be the cause of their sexual dysfunction. For some men, it may be more beneficial to work with a sex therapist or a doctor who specializes in sexual medicine. On the flip side, some men may wish to undergo circumcision as an adult due to concerns over the appearance of their penis. However like my pal the vulva, each penis is unique so I recommend embracing what you’ve got, foreskin or not! Besides in the end they all look the same when erect, some just get to sport a nifty turtleneck afterwards.

 

If you are still super bummed your foreskin is no more, at least know that it most likely went to a good cause. Often the  foreskin removed during a circumcision is used for research, to help graft new skin for medical procedures or burn victims or some are used to produce anti-wrinkle skin cream! Man, I love science!  So what do you think? Foreskin or no skin? Any guys out there who wish they had or hadn’t been circumcised? I’d love to hear from you!

 

Regards,

Rachel Gelman, DPT

 

Rachel-profile-pic2

Rachel is a Bay Area native, and currently practices in our San Francisco office. She received her bachelor’s degree in Biology from the University of Washington in Seattle and her Doctorate in Physical Therapy from Samuel Merritt University. Rachel grew up dancing and is excited to have recently returned to the dance studio. Outside of dance, Rachel enjoys going to the gym, discovering new brunch spots and spoiling her adorable niece and nephew.

Comments

  1. So glad to have another post about men. I read all of the posts, male or female, and get so much great info but as a male pelvic pain sufferer, so glad to get info directed at me too. Thanks for that! I’m 43 years old and have been dealing with pelvic pain for 4 yrs now. You’ll be glad to hear I’ve been seeing a pelvic floor PT specialist here in Austin Tx (Erin Arnold) for the last 3 yrs. The work has helped immensely but I’m still on the up and down road to recovery. Dealing with a flare of bacterial prostatitis amongst other issues at the moment. But, pertaining to the foreskin topic. One of my many pains is penis pain sometimes when flaccid, always with erection. While it’s still undetermined as to the root of the pain issue (dealing with more than just the bacterial infection) one thing I have noticed is tight scarring where I assume my circumcision took place, a red lump on the shaft just below the frenulum and an off center scar that goes down the bottom of my penis from the circumcision ring to about mid way down when flacid. The circumcision scar is not painful but there is a noticeable “tight ring” around the penis there when erect. The two other places are both sexually stimulating and painful at the same time-flaccid or erect. The pain starts at the lump or scar and connects through the perineum to the rectum. Any theories about these issues relating to circumcision? Any Therapy ideas about releasing the scar tissue or making these points less painful? Anyone else out there noticed issues with circumcision scars? Any help is greatly appreciated.
    Thanks!
    Wilson

    1. Hello Wilson,

      Thank you for sharing! Have you tried self massaging around the scar? It is difficult to know whether there are any other contributing factors without an evaluation. We recommend consulting with a local therapist for a full assessment.

      Best,

      Rachel

  2. As a male being uncircumcised, could that be another reason that I have Pfd and penile pain and having infections? I’m afraid of bringing this up to my Pt. This is a great website!!

    1. Hello Anonymous,

      Without an evaluation, it is difficult to know for sure. I recommend that you consult with a local therapist for more information.

      All my best,

      Rachel

  3. I am uncircumcised but I have been keeping my foreskin retracted for several years.
    I love the way it looks and feels. The penis is a lot cleaner. By wearing foreskin permanently retracted (autocircumcision), you get the advantages of circumcised and uncircumcised penises at the same time. I think that all boys with healthy foreskins should be educated about skinning back and about the benefits of doing so.
    What is your opinion on this matter?

    1. Author Rachel Gelman says:

      I get wanting the best of both worlds! However, keeping your foreskin retracted all the time could lead to problems. For instance, the foreskin could restrict blood flow to the glans (head) of your penis and that can be a medical emergency, which may lead to actual circumcision. I would recommend letting your foreskin be, but if you have concerns about appearance or cleanliness to talk to your primary care provider or local urologist for more information.

  4. I’ve experienced both. I got circumcised two years ago in my late 20’s for cosmetic reasons and partners preference. I notice my erections are a lot firmer after getting circumcised. Hygiene is improved. Appearance wise it looks better… I had the urologist go as far back as possible so there is no mobile shaft skin when I’m erect. I also have more intense orgasms from all of the direct stimulation to the head and shaft. As for my girlfriend she loves it, says she feels everything now, extra friction in the right places. I’d say we have sex almost twice as much. I also ejaculate with more force. Wish I would have done this sooner!

  5. What did mean when you said However, I highly advise that one DOES NOT attempt to restore his own foreskin with any of these “at-home” methods. They can easily cause damage to your penis or can result in pelvic floor dysfunction because of the consequences of the suggested strategies (trust me, I’ve seen it happen)!

    1. Author Rachel Gelman says:

      There are a lot of forums and sites online that recommend strategies to help “restore” the foreskin. The premise of most of these techniques is to stretch the penis in various fashions. These techniques can lead to over stretching and injury to the nerves and blood vessels in the penis and can negatively impact the muscles and connective tissue in the area as well. Basically, I recommend that a person doesn’t participate in these at home strategies. If someone has concerns regarding their penis they should consult a health care provider, like a urologist.

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